CD4+ dan Faktor yang Memengaruhi Kepatuhan Terapi Antiretroviral pada Orang dengan HIV/AIDS di Jayapura

Abstract Acquired Immune Deficiency Syndrome (AIDS) is one of the leading health problems in Papua and antiretroviral (ARV) therapy increases cluster of differentiation 4 (CD4+). We examined whether the CD4+ counts correlated with factors affecting adherence of ARV therapy in Papua. A cross-sectional study was conducted from June to September 2017 at VCT RSUD Dok II Jayapura. We assessed 85 respondents receiving ARV therapy for 12-24 months, who had fulfilled inclusion criteria agreed to sign the informed consent. Information of CD4+ and factors affecting adherence were obtained from blood samples analysis and questionnaires. Data were analyzed using Fisher exact test and Odds Ratio at p<0,05. The result showed that the high percentages of respondents’ characteristics include female, aged 15-30 years, employed, had formal education, indigenous Papuan, good treatment knowlegde, never switch ARV, had ARV side effects, had health insurance, never stigmatized, always got adherence counseling, easy access to health services, had family support, no community support. Most of the respondents were adherent to taking ARVs and had an increase in CD4+ cell counts. Women, working status, and stigma had a greater risk for immunodeficiency. Evaluation was required for respondents whose good adherence but did not experienced an increase in CD4+ cell counts. Keywords : CD4+, factors affecting adherence, ARV therapy, HIV/AIDS, Jayapura Abstrak Acquired Immune Deficiency Syndrome (AIDS) menjadi salah satu permasalahan kesehatan di Papua. Terapi antiretroviral (ARV) meningkatkan jumlah Cluster of Differentiation 4 (CD4+). Penelitian bertujuan menganalisis hubungan CD4+ dengan faktor yang memengaruhi kepatuhan terapi di Papua. Sampling dilakukan Juni sampai September 2017. Responden 85 pasien terapi ARV 12-24 bulan di VCT RSUD Dok II Jayapura yang telah memenuhi kriteria inklusi dan setuju untuk menandatangani informed consent. Data CD4+ dan faktor kepatuhan diperoleh dari pemeriksaan sampel darah dan kuesioner. Data dianalisis dengan uji Fisher exact dan Odds Ratio pada p <0,05. Hasil menunjukkan bahwa persentase karakteristik responden terbesar adalah perempuan, berumur 15-30 tahun, bekerja, sekolah dan asli Papua. Informasi berkaitan dengan ARV dengan persentase terbesar adalah pengetahuan pengobatan baik, tidak pernah ganti ARV pernah mengalami efek samping ARV, memiliki jaminan kesehatan, tidak pernah mengalami stigma, selalu mendapat konseling kepatuhan, akses layanan kesehatan mudah, mendapat dukungan keluarga, tidak mendapat dukungan komunitas. Mayoritas responden patuh minum ARV dan mengalami kenaikan jumlah CD4+. Perempuan, status bekerja, dan stigma memiliki risiko lebih besar untuk imunodefisiensi. Diperlukan evaluasi pada responden patuh minum ARV tetapi tidak mengalami kenaikan CD4+. Kata kunci : CD4+, faktor memengaruhi kepatuhan, terapi ARV, HIV/AIDS, Jayapur

Demographic and clinical characteristics associated with tobacco smoking and alcohol use disorder among heterosexual people living with HIV in West Papua, Indonesia

Introduction: Tobacco smoking and Alcohol use disorder (AUD) are common among People living with human immunodeficiency virus (PLHIV), which is associated with increased mortality and morbidity. This study aimed to determine the prevalence of tobacco smoking and AUD, as well as assess the factors associated with tobacco smoking and AUD among heterosexual PLHIV in West Papua. Methods: A cross-sectional study was conducted involving PLHIV on antiretroviral therapy (ART) at the voluntary counselling and testing (VCT) clinic in Manokwari, Sorong City, and Fak-Fak district. Data were collected from 237 PLHIV using a consecutive sampling technique and interview. Binary logistic regression analysis was performed to determine the prevalence and estimate the factors associated with current tobacco smoking and AUD. Results: The prevalence of tobacco smoking and AUD among PLHIV was 30.8% and 34.6%, respectively. There were statistically significant associated between tobacco smoking and gender (OR=2.881, CI=2.201-3.772), occupation (OR=1.375, CI=1.116-1.622), CD4+ count (OR=1.865, CI=1.865, CI=1.068-3.259) and opportunistic infections (OR=1.348, CI=1.054-1.7240. In addition, there were statistically significant associated between AUD and gender (OR=2.951, CI=2.16-3.930), occupation (OR=1.392, CI=1.178-1.645), CD4+ count (OR=1.769, CI=1.031-3.073), and opportunistic infections (OR=1.445, CI=1.134-1.842). Conclusions: Gender, occupation, CD4+ count levels, and opportunistic infection factors were associated with tobacco smoking and AUD among heterosexual PLHIV in West Papua. These findings highlight the critical need for an efficient cigarette and alcohol use control program for PLHIV in developing countries such as Indonesia, especially in West Papua

PREDICTOR OF ANEMIA AMONG PEOPLE LIVING WITH HIV TAKING TENOFOVIR+LAMIVUDINE+EFAVIRENZ THERAPY IN JAYAPURA, PAPUA

Background: The most common hematological abnormality among people infected with Human Immunodeficiency Virus (HIV) is anemia. This is also related to high mortality risk among patients receiving Antiretroviral Therapy (ART). Purpose: This study aimed to identify predictors of anemia among HIV patients taking ART using a regimen of the single-tablet drug contain tenofovir, lamivudine, and efavirenz in Jayapura, Papua. Methods: This was a cross-sectional study conducted at Jayapura regional hospital from June to September 2017. A total of 80 HIV patients were eligible for analysis. Data collection was conducted through an interview, medical record, measurement, and laboratory assay. The significance of differences among categorical variables was analyzed using Fisher’s exact test. The variables with p \u3c 0.25 were then analyzed using binary logistic regression to determine predictors associated with anemia. A threshold of p \u3c 0.05 indicates statistical significance. Results: This study showed that Body Mass Index (BMI) \u3c18.50 (p = 0.01; OR = 5.63; 95% CI = 1.43 \u3c OR \u3c 22.19), length on ART ≤12 months (p = 0.00; OR = 4.90; 95% CI = 1.65 \u3c OR \u3c 14.53), and Cluster of Differentiation 4 (CD4+) percentage out of normal (p = 0.02; OR = 0.19; 95% CI = 0.05 \u3c OR \u3c0.77) had a significant association with anemia. Conclusion: BMI, length on ART, and CD4+ percentage were predictors of anemia among HIV patients taking antiretroviral therapy containing tenofovir, lamivudine, and efavirenz regimen in Jayapura

Karakteristik Demografi ODHA di Papua

HIV dan AIDS merupakan salah satu permasalahan di Indonesia. Berdasarkan data dari Kementerian Kesehatan RI sampai dengan maret 2017, sebanyak 407 kota/kabupaten dari  507 kota/kabupaten dan lebih dari 87 ribu orang mengidap AIDS. Berbeda apabila dibandingkan dengan provinsi-provinsi lainnya, Papua mengalami epidemi HIV meluas tingkat rendah dengan prevalensi HIV sebesar 2.3 %. Jumlah penderita HIV lebih banyak terjadi pada perempuan usia reproduktif dibandingkan pada laki-laki. Meskipun HIV tersebar meluas di kelompok populasi umum baik untuk laki-laki maupun perempuan, kegiatan seks komersial memberikan kontribusi yang besar terhadap epidemi di semua wilayah Papua. Tujuan penelitian ini adalah menganalisis karakteristik demografi ODHA Di Papua Sebagai Baseline Data Di Indonesia. Penelitian dilakukan di tiga wilayah di Papua yaitu Kabupaten Nabire, Kab./Kota Jayapura, dan Kab. Jayawijaya dengan jumlah responden sebanyak 264 orang. Dari hasil penelitian yang dilakukan didapatkan hasil terdapat perbedaan karakteristik demografi ODHA di tiga wilayah Papua (Kabupaten Nabire, Kab./Kota Jayapura, dan Kab. Jayawijaya). Dari hasil penelitian dibutuhkan strategi penanganan ODHA yang berbeda di masing-masing wilayah

The demographic and clinical characteristics of women living with HIV and the opportunistic infections they experience in Manokwari Regency, West Papua

The number of women living with HIV (WLHIV) in Indonesia, especially Papua, is increasing yearly, along with the increasing number of men who transmit HIV to their partners. WLHIV are susceptible to opportunistic infections, leading to increased morbidity and mortality. This study, aiming to identify the characteristics and opportunistic infections among WLHIV in Manokwari Regency, West Papua, was descriptive with a cross-sectional study design involving 70 WLHIV who routinely received antiretroviral treatment at the VCT of RSUD Manokwari as respondent. Data on demographic and clinical variables were obtained through interviews using structured questionnaires. Data were analyzed by fisher exact tests to measure the association of opportunistic infections with demographic and clinical variables. The results showed that the demographic characteristics of WLHIV: aged18-35 years (47.1%), high school education (42.9%), private employment (47.1%), married (65.7%), ethnic Papuan (65.7%), and heterosexual risk factor (97.1%). Meanwhile, their clinical characteristics were clinical stage III (62.9%), CD4+ ≥350 cell/mm3 (62,9%), detectable viral load (55,7%), and underweight (38.6%). The most opportunistic infections among them were pulmonary tuberculosis (58.6%). The clinical stage of HIV and CD4+ cells was significantly associated with opportunistic infections among WLHIV. For these reasons, it is necessary to intervene by applying antiretroviral administration strategies and specific antimicrobial therapy

Body mass index increases CD4+ count in HIV/AIDS patients on first-line therapy

Background The body mass index (BMI) may contribute somewhat to drug metabolism, thus affecting the efficacy of antiretroviral therapy (ART). CD4+ counts   in people infected with HIV are essential in determining the stage of the disease, initiation of antiretroviral therapy, opportunistic infections and evaluating treatment outcomes. The aim of this study was to determine the association of BMI and clinical stage with CD4+ counts in HIV patients seeking treatment using first-line antiretroviral therapy (ART). Methods An analytic study with a cross-sectional approach was conducted involving 251 HIV/AIDS patients who had received first-line antiretrovirals over six months. BMI, clinical staging according to WHO and CD4 + were collected. Multiple linear regression was used to evaluate the relationship between BMI, clinical stage and CD4+. Results Among the enrolled patients, the median age was 36 years, 135 (55%) of the patients was female, 102 (40.6%) was overweight/obese, 161 (64.1%) was in stage 3 of the disease, and the median CD4+ count was 389 cells/mm3. Multiple linear regression test showed two variables with a significant effect on CD4+ count, namely BMI (B=69.247; 95 % CI : 42.886-95.608) and clinical stage (B=61.590; 28.910-94.270). BMI was the most influencing factor for CD4+ count (β=0.307) compared to clinical stage (β=0.216). Conclusions Body mass index was the most influencing factor for CD4 + counts of HIV/AIDS patients. Regular ART can increase CD4+ counts and maintain the health of HIV/AIDS patients

Gambaran Terapi Antiretroviral Pada Orang Dengan HIV/ AIDS di Manokwari, Fak-Fak dan Kota Sorong, Papua Barat

Antiretroviral therapy is used to suppress the HIV in People Living with HIV AIDS (PLWHA). This improves the life quality and prevents AIDS’s mortality. Manokwari, Fak-Fak and Sorong had high HIV AIDS cases in West Papua. The study’s aim was to overview the antiretroviral therapy by identifiying the adherence, clinical, and immunological condition of PLWHA in these 3 sites during August to October 2019. This was a cross sectional study. Respondents were 221 PLWHA, who receiving antiretroviral therapy for at least 6 months, male and female aged ≥15 years old. Data collections were through interviews, medical records, measurement and laboratory examinations. The data were processed statistically univariate and bivariate. Majority of respondents from all sites were 15-45 years old, women, married, senior high school-university graduated, employee, Papuan, no tuberculosis, stage 3-4 of HIV at beginning of therapy, normal Body Mass Index (BMI), CD4 + cell ≥350 cells/mm.³ The proportion of respondents with adherence ≥95% in Manokwari and Sorong were higher than in Fak-Fak, but the adherence in all sites were still not optimal yet. Most of respondents had good clinical and immunological conditions. There were relationship between tuberculosis, BMI, stage of HIV at beginning of therapy, and adherence to CD4 + counts after therapy. Keywords: antiretroviral, HIV/AIDS, adherence, clinical condition, CD4 + , West Papua Abstrak Terapi antiretroviral digunakan untuk menekan HIV pada Orang dengan HIV/AIDS (ODHA) karena mampu meningkatkan kualitas hidup dan mencegah kematian karena AIDS. Manokwari, Fak-Fak dan Kota Sorong memiliki kasus HIV AIDS tinggi di Papua Barat. Penelitian ini bertujuan menggambarkan terapi antiretroviral dengan mengidentifikasi kepatuhan pengobatan, kondisi klinis, dan imunologis ODHA di 3 lokasi tersebut pada Agustus sampai Oktober 2019. Desain penelitian adalah potong lintang. Responden sebanyak 221 ODHA dengan kriteria sedang terapi minimal 6 bulan, laki-laki dan perempuan berusia di atas 15 tahun. Data penelitian dikumpulkan dari wawancara, rekam medis, pengukuran dan pemeriksaan laboratorium. Data diolah univariat dan bivariat secara statistik. Hasil analisis menunjukkan mayoritas responden dari semua lokasi penelitian berusia 15-45 tahun, perempuan, menikah, pendidikan SLTA-Pendidikan Tinggi, bekerja, asli Papua, tidak ada tuberkulosis, sakit HIV stadium 3 dan 4 di awal terapi, Indeks Massa Tubuh normal, memiliki CD4 + ≥350 sel/mm³. Proporsi responden dengan tingkat kepatuhan ≥95% di Manokwari dan Sorong lebih tinggi dibandingkan di Fak-Fak, namun kepatuhan terapi di Manokwari, Fak-Fak, dan Kota Sorong masih belum optimal. Kondisi klinis serta imunologis sebagian besar responden relatif baik. Ada hubungan antara sakit TB, Indeks Massa Tubuh, stadium sakit HIV di awal terapi, dan kepatuhan dengan jumlah CD4 + setelah terapi. Kata kunci: antiretroviral, HIV/AIDS, kepatuhan, kondisi klinis, CD4 + , Papua Barat